Elizabeth Grace Braswell
Individual provider Active NPI Physician Assistant · Clinton, MS
NPI 1972332864 · NPPES record last updated Mar 17, 2025
Key facts
- NPI
- 1972332864
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA00875 (MS)
- Practice address
- 200 Capitol St
Clinton, MS 39056-4026 - Phone
- (601) 925-3000
- NPI assigned
- Jul 29, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250401003462 | MS | Practitioner - Physician Assistant | 2961925771 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA00875 | MS | MD | Physician Assistant |
Interoperability endpoints
- ebraswell587077@direct.bmhcc.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | PA00875 | MS | Yes |
Addresses
Primary practice location
200 Capitol St
Clinton, MS 39056-4026
Mailing address
200 Capitol St
Clinton, MS 39056-4026
Other providers in Clinton, MS
- Joseph Boone
- Spencer K Boothe
- Blake Bostick
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- Kimberly Charmaine Branson Williams
- Angela Bratton
- Janna Breland
- Allisha Brent-Rhodes
- Jazzmen Briscoe
- Bria Broussard
All providers in Clinton, MS · Physician Assistant in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.